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Profile of crescentic glomerulonephritis in Natal--a clinicopathological assessment
K B Parag1, A D Naran, Y K Seedat
1Department of Medicine, Medical School, University of Natal, Durban, Republic of South Africa.
Insights
Crescentic glomerulonephritis, a rapid kidney failure cause, has diverse origins. In South Africa, post-streptococcal nephritis was most common, with outcomes varying based on initial symptoms.
Area of Science:
- Nephrology
- Internal Medicine
- Pathology
Background:
- Crescentic glomerulonephritis (CGN) presents as rapidly progressive renal failure.
- Etiological factors for CGN vary globally, with limited data from Africa.
- This study investigates CGN in Natal, South Africa.
Purpose of the Study:
- To identify the causes and outcomes of CGN in a South African population.
- To compare findings with international CGN literature.
Main Methods:
- Retrospective analysis of 27 CGN cases from renal biopsies (1981-1987).
- Review of patient demographics, etiology, treatment, and outcomes.
- Categorization of CGN based on clinical and pathological findings.
Main Results:
- Post-streptococcal nephritis was the most frequent cause (n=8), followed by idiopathic CGN (n=9) and anti-glomerular basement membrane disease (n=4).
- Of 24 treated patients, 11 showed improvement with various therapies (immunosuppression, dialysis, plasmapheresis).
- Oliguria and severe renal failure at presentation indicated a poor prognosis.
Conclusions:
- CGN in this South African cohort was predominantly post-streptococcal or idiopathic.
- Treatment outcomes were variable, highlighting the need for early intervention.
- Severe presentation predicts a worse prognosis in CGN.
Abstract:
Crescentic glomerulonephritis is invariably associated with a fulminant syndrome of rapidly progressive renal failure which generally progresses to end-stage renal failure within weeks or months of onset. A widely differing aetiological background has been reported from Western countries. Work from the African continent is sparse. In a study from the province of Natal in South Africa between 1981 and 1987, 27 cases of crescentic nephritis were identified from a total of 458 patients who underwent renal biopsy at King Edward VIII and Addington hospitals. Poststreptococcal nephritis was the commonest aetiological factor (n = 8). There were six black patients in this group. Nine patients were classified as idiopathic and of these five were black. Four patients (one black) had antiglomerular basement membrane disease. Of the 24 patients subjected to variable combinations of immunosuppression, antiplatelet agents, dialysis and plasmapheresis, 11 improved, observed over four months to four years. Oliguria and severe renal failure at presentation signified a poor prognosis.